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Saturday, June 26, 2010

Dear Doctor

Advice about bedside manner.

 When a patient goes to see a doctor, they are seeking help or hoping for some solicitude or, at the very least, looking for a resource.  To truly accomplish any of these levels of care, the doctor has to listen to the patient.  It seems that we've all--doctors and patients alike--come to accept that  doctors are so busy that they can't really take the time to learn about each patient.  It seems generally accepted that they should be compromised in their ability to attend to a patient.   But, doctors, you've got to find a way:  You've got to find a way to pay attention.

I've had the bad experiences in doctors offices that most people have had.  I am a pretty pro-active patient and I go to a doctor's appointment prepared and, usually, with a purpose.  I would think an informed, focused patient would be welcome---with such a patient, the doctor doesn't have to do everything.  And, yet, I have sometimes been met with scorn because of this.  One doctor told me:  "Doctors don't like patients like you; you take too much time."  Another, because I came in asking for a specific test, said:  "You've been watching too much TV."

The first, at least had enough sense to recognize that I had done my research.  The second, in my assessment, had no realistic understanding of me as a person and, in addition, was demeaning in his remark (the second, I had been seeing for 6 years, believe it or not).  These doctors are not healers.

(rejection and devaluation do not make for healing.)

I have had a primary care physician who was a healer, and, a chiropractor who was a healer and a podiatrist who was a healer.  Have you ever looked for this quality in a health care provider?  When it is there, it is quite clear.  Mostly it is not there.
But it is interesting to look for it, and to develop the ability to identify it.

I wonder sometimes how people get motivated to become physicians.  Are they just students who are mostly interested in science?  Or, are they actually moved to help others and somehow lose the heart for that along the way?  One person can offer a healing interaction to another and those doctors who have that to offer are the  cream of the crop.  Wouldn't it be wonderful if patients could expect to feel at least a little bit, in some way, better after visiting a doctor?

Doctors, you need to be genuinely interested in your patient.  That's how you pay attention.  You have to give up the notion that 'one size fits all' and see each case as being unique.  Sometimes you have to have enough curiosity on board to 'play detective', to get going on trying to find the cause of a particular patient's problem rather than just treating the symptoms.

Recently, I had a good experience with the latter:  I had been having recurring flare-ups of an allergic skin reaction, mostly on my face.  I had seen each of the three dermatologists in this practice of four, numerous times over some years.  Finally one of them decided to "review the chart" and try to get to the bottom of it.  He also talked to me about my sensitive skin (to chemicals in cosmetics) in a clear but not condescending manner.  To make a long story short, I have not had an episode since that visit.  I had another good experience with my gynecologist recently and these two were unusual enough for me to write about it.

Upon reflection, what seemed different was the attitude (respect), the caring (attention), and the thinking (focus).  This part of treatment is, of course, what psychotherapists primarily do.  And we aren't perfect, we make mistakes.  But, most of us realize, hopefully, what a powerful position it is to be in--a doctor-patient relationship. and how critical even the smallest act of apparent de-valuing could be.  So, we try very hard to think before we speak, to keep in mind at all times, the vulnerability of the person before us, to never be off-handed in attitude, and to be in good shape ourselves when we go to work; we do rely a little, on the overall relationship, as able to carry the healing experience if we do flub up once in a while.

Doctors, maybe you don't get much training in counseling skills in medical school.  Is there a way that you could avail yourself of that training when already in practice?  One suggestion I have is that you engage a therapist to care for you.  Having the experience yourself, of being treated, always with dignity, with growing affection, and with respectful focus on whatever problem you might present---would be a great learning opportunity.  Being on the receiving end of this kind of care is one way to learn how to do it yourself.

Here is a link to an article which addresses the same issue but has the opposite emphasis.   If you read it, let me know what you think of that.

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